he University of Miami Medical Group (UMMG) recently closed the books on one of its most successful and challenging years ever. All the indicators of success of our clinical enterprise continue the strong growth trend of the past several years.

The Anne Bates Leach Eye Hospital was profitable for the first time since fiscal year 1996—patient revenue was up 10.6 percent, as expense increases were held to 8.3 percent.

The University of Miami Hospital and Clinics also had a banner year, beating the bottom line budget by nearly 600 percent after contributing more than $24 million to the academic, research, and clinical care missions.

The medical group also launched an ambitious long-term initiative to reform its governance and organizational structure and examine all of its business processes. The objectives are to create the safest possible environment for our patients and continually improve the service and care we provide.

Professional charges for the year increased 6.9 percent and collections were up 4.9 percent. Physician faculty grew from 770 to 777. Even malpractice expense, while remaining at an unsustainable level, showed some signs of improving. The number of open cases remained level despite the continued increases in practice volume and ever-increasing severity of the cases. The creation of a UM Office of Patient Protection and Risk Reduction paralleled a much more proactive posture in the management of cases and a more aggressive defense strategy. In the absence of legislative action to address this situation, the University is considering other far-reaching protective measures.

The future holds exciting prospects. As one of the few medical schools in the U.S. without its own teaching hospital, the University’s Board of Trustees recently authorized architectural fees to design a medical practice building that will include 140 inpatient beds. This will allow expansion of our limited inpatient capacity, greater expense control by merging practice operations, and opportunities for improved customer service.

For the past several months, Miller School of Medicine leadership also has been discussing an exciting initiative that would extend the practice into Broward and Palm Beach counties through a partnership with Florida Atlantic University and Boca Raton Community Hospital. The school has been developing a regional campus with FAU, and discussion has included expanding our clinical practice.

UMMG leadership has devoted considerable attention this year to improving the organization and management of the practice. All medical schools struggle with how best to organize this complex enterprise that has to deliver clinical care, train medical students, and undertake critically important biomedical research. The issues are always confounded by trying to manage an essentially retail venture—the clinical practice—within a University structure.

Our setup is representative of the majority of U.S. medical schools, with a mix of centralized and decentralized business operations. Over a year ago, however, the practice leadership under Jorge Guerra, M.D., began a process to reassess the organization, look for ways to deliver care more efficiently, and function more effectively within the University structure. The first phases of this revamping were completed this year with a substantial overhaul of the bylaws and governance structure. The UMMG Board of Directors will soon review a proposed funds flow and faculty compensation framework.

In short, it has been an exciting year full of accomplishments, with plenty of challenges ahead. The clinical practice—the largest multi-specialty practice group in the Southeast—is well positioned for even greater achievement.